FDA Adverse Event
Injury
Summary report: N
AFFINITY SR
MDR report key: 4191739
·
Received January 13, 2014
Report
- Report Number
- 2017865-2014-04790
- Event Type
- Injury
- Date Received
- January 13, 2014
- Date of Event
- August 1, 2012
- Manufacturer
- ST. JUDE MEDICAL, INC., CRMD
- Product Code
- LWP
- PMA / PMN Number
- P880086
- Adverse Event
- Yes
- Product Problem
- Yes
- Report Source
- Manufacturer report
- Reporter Location
- PO
- Reporter Occupation
- PHYSICIAN
Narratives
Additional Manufacturer Narrative · 1
ALL INFORMATION PROVIDED BY MANUFACTURER, NO MEDWATCH FORM WAS RECEIVED. THIS HISTORICAL COMPLAINT IS BEING FILED AS PART OF A RETROSPECTIVE REVIEW OF COMPLAINT FILES IN RESPONSE TO A RECENT FDA INSPECTION. THERE IS NO CHANGE TO THE ACTUAL PERFORMANCE OF THE PRODUCT AND THIS REPORT ONLY REPRESENTS AN ENHANCEMENT TO THE REPORTING CRITERIA GOING FORWARD. THE REPORTED FIELD EVENT OF BACKUP VVI MODE AND END OF LIFE INDICATOR WAS CONFIRMED. THE CAUSE OF HIGH CURRENT DRAIN AND LOSS OF OUTPUT WAS FOUND TO BE DAMAGED INTEGRATED CHIP DUE TO EXTERNAL DEFIBRILLATION.
Description of Event or Problem · 1
IT WAS REPORTED THAT THE PULSE GENERATOR REACHED ELECTIVE REPLACEMENT INDICATOR.
Devices
| Seq | Brand | Generic | Product Code | Manufacturer | Model | Lot | UDI-DI |
|---|---|---|---|---|---|---|---|
| 29792 | AFFINITY SR | IMPLANTABLE PACEMAKER PULSE GENERATOR, LWP | LWP | ST. JUDE MEDICAL, INC., CRMD | 5130 |
Patients
| Seq | Age | Sex | Outcome | Treatment |
|---|---|---|---|---|
| 1 | 77 YR | Required Intervention |